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Orthognathic /Jaw Surgery in Patients with Clefts

Does your child really have a large lower jaw or “underbite”? Children and teenagers with a history of facial clefting often have the appearance of a large lower jaw. Actually a very small amount of these patients have a true large lower jaw (also called mandibular hyperplasia). What is really happening is they have a small upper jaw (or maxillary hypoplasia). Because the teeth are connected to the jaws, this gives the appearance of an underbite. You may hear your orthodontist or surgeon refer to this as a Class III malocclusion.

Why does my child have a small upper jaw?

There are many reasons why your child may have a small upper jaw. Primarily, a cleft lip, cleft palate or other types of facial clefting can cause problems with the growth of the upper jaw.

How do I fix the small upper jaw?

Many patients with cleft lip/palate do not require jaw surgery or simply need some braces. Some though do require surgery to reposition their jaws when they are teenagers. This is called orthognathic surgery. Repositioning the jaws is completed at the end of the child’s growth in conjunction with braces or orthodontic treatment.

Orthognathic/jaw surgery in children with clefts is completed in three different steps:

  • Step 1: Diagnosis of the Facial/Jaw Deformity. Diagnosing where the problem lies is critical to performing the correct surgery. This is completed by a thorough clinical assessment and exam, photographs, dental impressions or molds and x-rays or even CT scans.
  • Step 2: Treatment Planning. Models of the jaws are created to help plan the surgery. Surgery is actually performed on the models to see how to best bring the teeth and jaws together.
  • Step 3: Performing Surgery. Finally surgical guides are made from these operated models in the lab. We then transfer these to the operating room allowing us to know where to place the jaws.

At the end of surgery, not only does your child have teeth that come together but a positive balance to their face! If your child looks like they have a large lower jaw, call the Cleft and Craniofacial Clinic at Riley at IU Health. To schedule an appointment to meet our reconstructive team please call 317.274.2489.

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